I understand that the personal information on this form is collected by the City of Coquitlam for the purposes of the Arts and Culture Entertainment Program, under the authority of section 26(c) of the Freedom of Information and Protection of Privacy Act. Successful applicants will have their name publicized as part of the promotion of the associated event. If you have any questions about the collection of information, please contact Karen Basi - City of Coquitlam, Parks Recreation and Culture at 604-927-6962.
This field is not part of the form submission.
* indicates a required field